diabetes (diabetes mellitus, SD) is a chronic metabolic disease that manifests itself in the form of absolute or relative deficiency of pancreatic protein hormones in the blood called insulin, and is characterized by violations of dextrose metabolism in the body - persistent hyperglycemia, which then leads to disorders of metabolism of fats, proteins, mineral salts and water.
Next, you will learn: what is diabetes mellitus, its main types, symptoms and treatment methods.
Type of diabetes mellitus (classification)
Classification of diabetes mellitus by cause:
Type 1 diabetes- characterized by an absolute lack of insulin in the blood:
- Autoimmune - antibodies attack the cells of the pancreas and destroy them completely;
- Idiopathic (no cause known);
Type 2 diabetes- relative lack of insulin in the blood. This means that quantitative indicators of insulin levels remain in the normal range, but the number of receptors for hormones on target cell membranes (brain, liver, adipose tissue, muscle) decreases.
Diabetes during pregnancy- acute or chronic conditions, which are manifested in the form of hyperglycemia during pregnancy of women.
Another cause (situation) of diabetes- impaired glucose tolerance due to causes unrelated to pancreatic pathology. They can be temporary and permanent.
Types of Diabetes:
drugs;
contagious;
genetic defects in insulin molecules or their receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing disease;
- adrenal adenoma;
- Graves' disease.
Classification of diabetes by severity:
Lightweight shape- characterized by hyperglycemia not more than 8 mmol / l, slight daily fluctuations in sugar levels, the absence of glucosuria (sugar in the urine). Does not require pharmacological correction with insulin.
Often, at this stage, clinical manifestations of the disease may not be present, however, during instrumental diagnostics, early forms of typical complications with damage to peripheral nerves, retinal micro -channels, kidneys, and heart are already detected.
Moderate severity- the level of glucose in the peripheral blood reaches 14 mmol / l, glucosuria appears (up to 40 g / l), which entersketoacidosis- a sharp increase in body ketones (metabolites of fat breakdown).
Ketone bodies are formed as a result of cellular energy starvation. Almost all of the glucose circulates in the blood and does not enter the cells, and it begins to use up fat reserves to produce ATP. At this stage, glucose levels are controlled with the help of dietary therapy, the use of oral hypoglycemic drugs.
Clinically indicated by impaired renal function, cardiovascular system, vision, neurological symptoms.
Severe situation- blood sugar exceeds 14 mmol / l, with fluctuations up to 20-30 mmol, glycosuria exceeds 50 mmol / l. Complete dependence on insulin therapy, serious dysfunction of blood vessels, nerves, organ systems.
Classification according to the degree of compensation of hyperglycemia:
Reparation- this is a conditional normal state of the body with the presence of an incurable chronic disease. The disease has 3 phases:
Reparation- diet or insulin therapy allows you to achieve normal blood glucose levels. Angiopathy and neuropathy do not develop. The general condition of the patient remained satisfactory for a long time. No violation of sugar metabolism in the kidneys, the absence of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%";
Small compensation- treatment does not completely correct the blood count and clinical manifestations of the disease. Blood glucose is not higher than 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to micro -channels in the kidneys manifests itself in the form of small amounts of glucose in the urine (up to 40 g / l). Acetone in urine is not detected, however, mild manifestations of ketoacidosis are possible;
Decompensation- the worst phase of diabetics. It usually occurs in the late stages of the disease or total damage to the pancreas, as well as insulin receptors. It is characterized by the general condition of the patient severe up to coma. Glucose levels cannot be corrected with the help of pharmaceuticals. drug (over 14 mmol / l). High amount of sugar in urine (over 50 g / l), acetone. Hemoglobin glycosylation significantly exceeds the norm, hypoxia occurs. With a long course, this condition leads to coma and death.
Causes of diabetes
Diabetes mellitus (abbreviated DM) is a polyethological disease.
There is no single factor that will cause diabetes in everyone with this pathology.
The most important reasons for the development of the disease:
Type I diabetes mellitus:
Genetic causes of diabetes:
- congenital deficiency of pancreatic β cells;
- hereditary mutations in genes responsible for insulin synthesis;
- genetic predisposition to immune autoaggression to β-cells (closest relative is diabetes);
Infectious causes of diabetes mellitus are pancreatotropic viruses (affecting the pancreas): rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells along with this virus, which causes diabetes mellitus.
Type II diabetes has the following causes:
- heredity (presence of diabetes in the immediate family);
- profound obesity;
- age (usually older than 50-60 years);
- low fiber intake and high intake of refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
Provoking factors
This group of factors does not by itself cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesiti;
- smoking;
- excessive alcohol consumption;
- use of substances that affect the pancreas (e. g. , drugs);
- excess fats and simple carbohydrates in the diet.
Symptoms of Diabetes
Diabetes is a chronic disease, so symptoms never appear suddenly. The symptoms in women and the symptoms in men are almost the same. With this disease, the manifestation of the following clinical signs is possible to varying degrees.
- Persistent weakness, declining performance- develops as a result of chronic energy starvation of brain cells and skeletal muscle;
- Dryness and itching of the skin- due to persistent loss of fluid in the urine;
- Dizziness, headache- signs of diabetes - caused by a lack of glucose in the blood circulating in the cerebral vessels;
- Frequent urination- occurs as a result of damage to the glomerular capillaries of the renal nephron;
- Decreased immunity (frequent SARS, prolonged non -healing wounds on the skin)- T cell immune activity is impaired, the skin performs a more severe barrier function;
- Polyphagia- persistent hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport into the cells;
- Decreased vision- cause - damage to the microscopic retinal canal;
- Polydipsia- persistent thirst due to frequent urination;
- Numbness in the limbs- prolonged hyperglycemia leads to certain polyneuropathy - damage to sensory nerves throughout the body;
- Pain in the heart area- narrowing of the coronary arteries due to atherosclerosis leads to decreased myocardial blood supply and spastic pain;
- Decreased sexual function- is directly related to poor blood circulation in the organs that produce sex hormones.
Diagnosis of diabetes
The diagnosis of diabetes usually does not cause difficulties for a qualified specialist. Doctors may suspect this disease, based on the following factors:
- Diabetic patients complain of polyuria (increased daily urine volume), polyphagia (persistent hunger), weakness, headache and other clinical symptoms.
- During a preventive blood test for glucose levels, the indicator is above 6. 1 mmol / l on an empty stomach, or 11. 1 mmol / l 2 hours after a meal.
If this symptomatology is detected, a series of tests are performed to confirm / refute the diagnosis and to determine the cause.
Diabetes Laboratory Diagnosis
Oral glucose tolerance test (OGTT)
Standard tests to determine the functional ability of insulin to bind glucose and maintain normal levels in the blood.
The essence of the method:in the morning, with an 8 -hour fasting background, blood was taken to assess fasting glucose levels. After 5 minutes, the doctor gave the patient to drink 75 g of glucose dissolved in 250 ml of water. After 2 hours, blood was taken again and sugar levels were reset.
During this period, early symptoms of diabetes usually appear.
Criteria for evaluating OGTT analysis:
| norm | |
| on an empty stomach | < 5. 6 |
| 2 hours after OGTT | < 7. 8 |
| Diabetes mellitus (requires differential diagnosis for type 2 diabetes) | |
| on an empty stomach | 6. 1 |
| 2 hours after OGTT | 11. 1 |
| random definition | 11. 1 |
Determination of glycosylated hemoglobin (C - HbA1c) levels
Classified hemoglobin or HbA1c- this is erythrocyte hemoglobin, undergoing transformation due to contact with glucose. Its concentration in the blood has a direct correlation with glucose levels, which makes it possible to assess the compensation of the condition of diabetics.
The norm is up to 6%.
- Doubtful results - 6-6. 4%;
- In diabetes mellitus - more than 6. 4%.
Determination of C-peptide levels
C-peptideis a fragment of the proinsulin molecule. When C-peptides are cleaved, insulin becomes functionally active. The concentration of this substance in the blood allows you to assess the secretion of insulin in the pancreas.
Norm: 0. 79-1. 90 ng / ml (SI: 0. 27-0. 64 mmol / l).
Determination of proinsulin levels
This test allows you to differentiate between various pancreatic diseases and diabetes. Elevated blood proinsulin most often indicates an endocrine tumor - insulinoma (a relatively rare pathology). Also, high concentrations of proinsulin molecules may indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of antibody levels to pancreatic beta cells
One of the most accurate tests to determine the presence and cause of diabetes. The test is performed in at -risk groups (people with a predisposition to diabetes, for example, if a close relative has the disease), as well as in patients whose glucose tolerance is impaired during OGTT.
The higher the specific antibody titer, the greater the likelihood of the autoimmune etiology of the disease, and the faster beta cells are destroyed and insulin levels in the blood decrease. In diabetics, it usually exceeds 1: 10.
Norma - Titer: less than 1: 5.
If the antibody titer remains in the normal range, but the fasting glucose concentration exceeds 6. 1, the diagnosis is type 2 diabetes mellitus.
Insulin antibody levels
Another special immunological test. It is performed for the differential diagnosis in diabetic patients (type 1 diabetes and type 2 diabetes). If glucose tolerance is impaired, blood is taken and serological tests are performed. It can also indicate the cause of diabetes.
The norm of AT to insulin is 0-10 IU / ml.
- If the C (AT) is higher than normal, the diagnosis is type 1 diabetes. Autoimmune diabetes mellitus;
- If C (AT) is within the reference value, the diagnosis is type 2 diabetes.
GAD (Glutamic Acid Decarboxylase) Antibody Test.
GAD is a specific membrane enzyme of the central nervous system. The logical correlation between the concentration of antibodies to GAD and the development of type 1 diabetes is still unclear, however, in 80–90% of patients, these antibodies are detected in the blood. Analysis for AT GAD is recommended in risk groups to diagnose prediabetes and prescribe a preventive diet and pharmacological therapy.
Norma AT GAD - 0-5 IU / ml.
- Positive results with normal glycemia indicate a high risk of type 1 diabetes;
- Negative results with high blood glucose levels indicate the development of type 2 diabetes.
Blood insulin test
Insulin- a highly active hormone of the endocrine part of the pancreas, synthesized in the beta cells of the islets of Langerhans. Its main function is to transport glucose into somatic cells. Decreased insulin levels are the most important link in the pathogenesis of the disease.
The norm of insulin concentration is 2. 6-24. 9 mcU / ml
- Below the norm - the possibility of the development of diabetes and other diseases;
- Above normal - pancreatic tumor (insulinoma).
Instrumental Diagnosis of Diabetes
Ultrasound of the pancreas
The ultrasound scanning method allows you to detect morphological changes in the glandular tissue.
Typically, in diabetes mellitus, pervasive damage is determined (areas of sclerosis - active cell replacement functioning with connective tissue).
Also, the pancreas can be enlarged, having signs of edema.
Lower vessel angiography
The lower arteries are the target organs in diabetes mellitus. Prolonged hyperglycemia causes an increase in blood cholesterol and atherosclerosis, which leads to a decrease in tissue perfusion.
The essence of this method is the introduction of special contrast agents into the bloodstream with simultaneous control of vascular patency on computed tomographs.
If the blood supply is significantly reduced at the level of the lower leg, so -called "diabetic legs" form. The diagnosis of diabetes mellitus is based on this research method.
Ultrasound of the kidneys and ECHO KG of the heart
The method of instrumental examination of the kidneys, allows to assess damage to these organs in the presence of a diagnosis of diabetes mellitus.
Microangiopathy develops in the heart and kidneys - damage to blood vessels with a significant decrease in their lumen, and therefore a deterioration in functional ability. This method allows to prevent complications of diabetes mellitus.
Retinography or angiography of the retinal canal
The microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of damage in them begins even before the first clinical signs of diabetes mellitus.
With the help of contrast, the degree of narrowing or complete blockage of the vessel is determined. Also, the most important sign of DM is the presence of microerocytes and ulcers in the fundus.
The diagnosis of diabetes mellitus is a complex step, which is based on the history of the disease, objective examination by a specialist, laboratory tests and instrumental studies. Using only one diagnostic criterion, it is impossible to establish a 100%correct diagnosis.
If you are at risk, be sure to consult with your doctor to learn more about what diabetes is and what to do with such a diagnosis.
Treatment
Treatment of diabetes mellitus is a set of measures to correct the levels of glycemia, cholesterol, body ketones, acetone, lactic acid, prevent the rapid development of complications and improve the quality of human life.
In diabetes, a very important aspect is the use of all treatment methods.
Methods used in the treatment of diabetes:
- Pharmacological therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent the progression of the disease and the development of complications;
- Psychological support.
Type 1 Diabetes Treatment
Pharmacological correction with insulin
The requirements for insulin injections in diabetic patients, the type and frequency of its administration are individual and selected by specialists (therapists, endocrinologists, cardiologists, neuropathologists, hepatologists, diabetics). They constantly pay attention to the symptoms of diabetes, conduct a differential diagnosis, examination and evaluation of the effectiveness of drugs.
Insulin type:
- act fast(ultra-short action)-begins to act immediately after administration and works within 3-4 hours. Used before or immediately after meals;
- short action- act 20-30 minutes after administration. It should be applied strictly 10-15 minutes before eating;
- medium period- is used for continuous reception and acts within 12-18 hours after injection. Helps prevent complications of diabetes;
- Insulin is long acting- requires continuous daily use. Valid from 18 to 24 hours. It is not used to lower blood glucose levels, but only controls its daily concentration and does not allow an excess of normal values;
- Combined insulin-contains in various ratios ultrashort-acting insulin and long-acting insulin. It is used mainly in the intensive treatment of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in controlling glycemic levels in patients with diabetes mellitus.
What foods should be eaten?
- Fruits and vegetables with low sugar levels and high concentrations of vitamins and minerals (apples, carrots, cabbage, beets);
- Meats that contain little animal fat (beef, turkey, quail);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably sea);
- Instead of drinks it is better to choose weak tea, fruit decoction.
What to discard:
- Sweets, pasta, flour;
- concentrated juice;
- Fatty meats and dairy products;
- Spicy and smoky foods;
- Alcohol.
Type 2 Diabetes Treatment
In the early stages, type 2 diabetes mellitus is well treated with dietary therapy, similar to type 1 diabetes. If diet is not followed, as well as with prolonged illness, pharmacological therapy with hypoglycemic drugs is used. More rarely, patients with type 2 diabetes are given insulin.
Hypoglycemic drugs
- drugs that stimulate insulin production in the pancreas.
- stimulates beta cells to produce insulin.
- functions in the intestine, inhibiting the activity of small intestinal enzymes that break down polysaccharides into glucose.
- drugs for the prevention of polyneuropathy, micro and macroangiopathy of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
Folk methods include the preparation of various decoctions of herbs, fruits and vegetables, to one degree or another correct the level of glycemia.
- kryphea amur- Ready extract of moss. The use of Criphea causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has anti-allergic and immunomodulatory effects, reducing the main symptoms of diabetes.
- Parsley Root + Lemon Peel + Garlic- This product contains large amounts of vitamins C, E, A, selenium and other trace elements. All of this must be crushed, mixed and infused for about 2 weeks. Use orally 1 teaspoon before meals.
- oak seeds- contains tannins, a very effective remedy for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the walls of blood vessels, relieves the obvious type. Acorns must be ground into a powder and taken 1 teaspoon before each meal.
Physical exercise in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of complications of diabetes mellitus. Morning exercise, running, swimming help prevent obesity, increase blood supply to muscles and organs, strengthen blood vessels, and stabilize the nervous system.
Disease prevention
With a genetic predisposition, the disease is unavoidable. However, people at risk need to take some steps to control glycemia and the rate of development of diabetic complications.
- Children with unwanted offspring (parents, grandparents with diabetes) should be tested for blood sugar levels once a year, as well as monitor their condition and the appearance of the first symptoms of the disease. Also, an important step is an annual consultation with an ophthalmologist, neuropathologist, endocrinologist, cardiologist to determine the first symptoms of diabetes, to prevent complications of diabetes.
- People over the age of 40 need to have their glycemic levels checked annually to prevent type 2 diabetes;
- All diabetics need to use a special device to monitor blood sugar levels - glucometer.
You also need to know everything about diabetes - what is possible, what is not, starting from the type and ending with the cause of the disease specific to you, for this you need a long conversation with a doctor, he will consult, instruct you to pass a testrequired and prescribe treatment.
recovery prognosis
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern advances in pharmacological insulin therapy can significantly prolong the life of diabetic patients, and the common diagnosis of typical organ system disorders leads to an improvement in the quality of life of patients.